儿童百日咳临床特征及病程影响因素探讨

Clinical analysis of children with pertussis and the factors affecting the course of disease

目的探讨儿童百日咳临床特征及预后影响因素。方法收集2016年1月至2017年7月西安交通大学附属儿童医院收治的554例百日咳患儿的病例资料,对其临床特征、实验室检查结果进行回顾性分析,并按年龄、性别、免疫状态、病情严重程度、是否合并感染进行分组比较。结果(1)在554例患儿中男性284例(51.3%),女性270例(48.7%);<1岁者386例(69.7%),未进行免疫接种者246例(44.4%);普通型百日咳535例(96.6%),重型百日咳19例(3.4%)均预后良好;单纯感染373例(67.3%),混合感染181例(32.7%),常见合并感染病原为流感病毒、合胞病毒、腺病毒、肺炎支原体和肺炎链球菌等,其中病毒感染占到72.4%;2例诊断百日咳脑病,均发生在<3个月组;320例(57.8%)影像学资料提示合并肺炎。(2)在554例中,237例白细胞计数(WBC)>12.0×109/L,平均采血时间在起病16.9天,217例WBC≤12.0×109/L,平均采血时间在起病32.0天;血小板计数(PLT)仅1例降低,274例(49.5%)正常,279例(50.3%)>400×109/L;超敏C反应蛋白(hsCRP)平均值为1.37±2.30mg/L;降钙素原(PCT)值32例缺失,9例>0.1ng/mL,其余513例(93.1%)均≤0.1ng/mL。(3)呼吸暂停、肺炎、重症病例均以未接种组发生率最高(χ2值分别为30.434、20.173、17.317,均P<0.05),痉挛性咳嗽、鸡鸣样回声、喘息、腹泻均在1岁以内组发生率高(χ2值分别为7.842、20.061、10.590、31.191,均P<0.05),肺炎在3岁以上组发生率明显降低,差异具有统计学意义(χ2=20.248,P<0.05)。(4)平均住院日随着年龄的增长、免疫剂次的增加而缩短。外周血白细胞越高,病程越短者,差异更具有统计学意义[Exp(B):1.022,95%CI:1.009~1.035,P<0.05]。结论百日咳多见<1岁的婴幼儿,发病无性别差异,大多预后良好,合并感染以病毒多见,治疗时应尽量避免盲目升级抗生素。hsCRP和PCT对百日咳博德特菌感染诊断无指导意义。患儿发病年龄越小,免疫剂次越不完善,临床症状越重。外周血白细胞越高,病程持续时间越短。

Objective To analyze the clinical features and prognostic factors of pertussis in children.Methods Data of 554 children with pertussis admitted in Xi＇an Children＇s Hospital Affiliated to Xi＇an Jiaotong University from January 2016 to July 2017 was collected.Clinical features and laboratory test results were retrospectively analyzed.Grouping comparison was performed based on age,sex,vaccination status,illness severity and occurrence of combined infection.Results In 554 patients,284 cases were male（51.3%）and 270 were female（48.7%）.Among them 386 cases（69.7%）were less than 1 year old,and 246 cases（44.4%）cases were unvaccinated.Altogether 535 cases（96.6%）had common pertussis and 19 cases（3.4%）had severe pertussis,and all cases had good prognosis.Pure bordetella pertussis infection was seen in 373（67.3%）cases,and 181（32.7%）cases had mixed infection.Common pathogens of mixed infection were influenza virus,syncytial virus,adenovirus, mycoplasma and streptococcus pneumoniae.Viral infection occupied 72.4%in mixed infections.Two cases were complicated with encephalopathy,and both were less than 3 months old.Imaging data of 320 cases（57.8%）indicated combined pneumonia.Among 554 cases white blood cell（WBC）count in 237 cases was above 12.0×10^9/L,with average blood collection time at 16.9 day after disease onset and WBC in217 cases was no more than 12.0×10^9/L,with average blood collection time at 32.0 day after onset.Platelet（PLT）count was decreased in only 1 case,normal in 274（49.5%）cases,and no less than 400×10^9/L in 279 cases（50.3%）.Average value of high sensitive C-reactive protein（Hs-CRP）was 1.37±2.30 mg/L.Procalcitonin（PCT）value was lost in 32 cases,above 0.1 ng/mL in9 cases and no more than 0.1 ng/mL in remaining 513 cases（93.1%）.Incidences of apnea,pneumonia and severe cases were highest in unimmunized group（χ2 value was 30.434,20.173 and 17.317,respectively,all P 0.05）.Incidences of spasmodic cough,inspiratory whoop,pant and diarrhea were highest in less than 1 year old group（χ2 value was 7.842,20.061,10.590 and31.191,respectively,all P〈0.05）.Incidence of pneumonia decreased significantly in over 3 years old group and difference had statistical significance（χ2=20.248,all P〈0.05）.Average days of hospitalization were shortened with increase in age and number of immunizations,and difference was more significant in patients with higher peripheral white blood cells and shorter disease course[Exp（B）：1.022,95%CI：1.009-1.035,P〈0.05].Conclusion Pertussis occurs mostly in infants less than 1 year old.It has no gender differences.Most cases have good prognosis.Viruses are most common co-infection pathogen,so treatment with upgraded antibiotics should be avoided.Hs-CRP and PCT have no significance in diagnosis of pertussis.The younger the children and the more imperfect the immunizing,the heavier the symptoms.The more the white blood cells in peripheral blood,the shorter the duration of disease.